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Welcome all seeking refuge from low carb dogma!

“To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact”
~ Charles Darwin (it's evolutionary baybeee!)

Thursday, July 14, 2011

The Nutrition and Metabolism Society's Ad Campaign Smear of Hope Warshaw

The web went ablaze this past week or so over the ADA's Hope Warshaw, who penned a piece for Diabetes Health.  Judging from the reaction some might think is was akin to Mein Kamf  or something.  I mean the hypocrisy of those in the extended LLVLC community is just too much to bear at times.  What did Hope Warshaw write that was so inflammatory?  It's a short piece, but it boils down to this:
  • Apparently Warshaw makes the claim that low carb is "old dogma" in diabetes circles, and
  • Warshaw advocates eating a slightly higher carb (45%-65%) diet that by virtue of macronutrient ratios will result in a lower fat intake compared to the current (45%) average carb consumption.  
  • Advocacy of earlier pharmaceutical intervention upon diagnosis.
  • Cognition that weight loss is most effective in the first months or years following diagnosis and basically that we should be proactive with "prediabetes" screenings and diagnoses.
Oh the horror!  String her up now!!

For saying this, the woman has been maliciously attacked and maligned.  Now, let's be clear, I think a big part of the problem here is talking in terms of percents and not in terms of absolute consumption.  Another issue is lumping veggie and, yes, whole fruit carbs in with sugar and flour products.  I agree, this focus on whole grains is misguided, woefully so!, but one really has to ask themselves this:  What is the evidence that using insulin -- the hormone of life! -- to supplement the normal hormonal response of a failing pancreas is any more or less healthy than chronically stressing one's liver to meet glucose needs.  The number of hypothyroids who have no compunction upping their meds when LC tanks their thyroids further is rather astonishing to me, but take insulin?  No!  For Warshaw to suggest that full-fledged diabetics get on an appropriate insulin regime to manage their blood glucose levels is tantamount to harming people.  Criminal if some are to be taken seriously.  OK.  

Although he's not really a LLVLC shill, Steve Cooksey got the ball rolling with:
Has any ADA Minion harmed as many people as Hope Warshaw???   I hope not. ...
... She issues terrible advice to diabetics that only accomplish two things….
1) Keeps diabetics on ever increasing amounts of drugs and insulin.
2) Keeps diabetics requiring her books and services. 
Well, let's see.  Is there ANY evidence that those who actually follow (not try, pretend to or claim to), but actually follow the so-called ADA diet will need ever increasing amounts of drugs and insulin?  And is there really any hard data, not anecdotes, but hard data that long term following a VLC diet is any more protective of beta cells over the long haul?  It seems to me that the jury is still out in this regard because the problem in T2 is insulin resistance, not  insulin.  Of course, apparently, needing metformin to keep fasting BG's down as eventually the pancreas is no longer able to support basal insulin is OK.  Or is it ... we'll get to that.  As to keeping diabetics requiring her books and services?  Well, I suppose that's fair.  I await Cooksey's denunciation of all of the LC "candy cigarette" pushers and retailers and cookbook authors.  Make no mention of the seemingly endless "new" books touting LC while success stories over a year or so old remain harder to find than a shirtless picture of Fred Hahn.

So, of course Jimmy Moore had to weigh in (actually it's been a while since he's done that publicly ...) with:
One of the things I try really hard to avoid doing at my blog is making the subject of my criticisms the people and personalities involved rather than the issue at hand. But in the case of registered dietitian and self-proclaimed diabetes “expert” Hope Warshaw, I have to make an exception because she has crossed the line into causing more harm than good with her irresponsible advice for people living with Type 2 diabetes.
Profanity alert:  Oh *cough* bull shit Jimmy!  < / profanity > 

Firstly you may want to revisit some of your own comments about yours truly on your blog.  But more importantly, I'd like to see you search on "idiots" in all your so-called debunkings of researchers to see just how many times you use that term to deride scientists and doctors with whom you disagree.  I emailed you on one extremely egregious occasion when you lambasted researchers for ignoring a previous study (remember that mood study?).  It was pathetic how you accused these researchers who not only acknowledged said previous study, but, since they were the actual authors of it, clearly stated the current work built upon it.  Remember that?  Doubtful.   

Again, what line has she really crossed here?  A sampling of Jimmy's issues:

  • Research from GardnerShaiFoster and others has proven low-carb diets effectively control blood sugars

  • Well, if you're going to cite Shai, then you should also now by now that the highest carb consuming Mediterranean group fared better than the LC group.  Yeah, I know, I know.  When one points this out this is when the cult falls back on the "well it wasn't really a true LC diet" mantra ...  Can't have it both ways folks.  Just can't.

  • Encouraging carb consumption for diabetics makes the disease worse

  • Proof?
    • Sugary fruits, starchy veggies, and whole grains increase blood sugars
    • Any food that spikes blood sugar cannot be described as “healthy”
    • Low-fat dairy contains more lactose that will raise blood sugars
    So? And as to bullet point #2 above, that is just absurd. Such a statement is not based on science by any stretch of even Jimmy Moore's imagination.

  • High-carb diets demand the use of more medications and insulin 


  • Eating carbohydrates WILL require medication

  • It is true that the diabetics Warshaw is talking about -- those with longstanding diagnoses and irreversibly compromised beta cells -- will likely require more insulin to handle dietary carbohydrate.  But carbohydrates, contrary to Taubes' mythology, enhance rather than cause insulin resistance.  There's certainly no evidence that I'm aware of that the long term use of insulin causes any more rapid deterioration of the remaining beta cells.  There's evidence that some of the newer meds can even help increase beta cell mass.  Indeed if the whole exausting the pancreas theory were true (it appears by all indications not to be), it should forestall the progression.

  • Reducing medication should be a sign of improvement for diabetics

  • Not necessarily.    A better sign of improvement for diabetics is restoring proper insulin secretion. I could go on with the rest of Jimmy's list but it would be a waste of time.  For Tom - Fat-Head - Naughton, not one, not two but three (so far?) posts were required to put down Hope Warshaw.   Gotta love a good comedian.  But speaking of Mein Kamf, one can't help but notice the rather distasteful Nazi insinuations in his first post.  Yes folks, those benevolent low carbers who just want to spread the truth in an open and transparent manner are the "Allies" while the opposition is the "Axis".  Nice, huh?  

    Tom regurgitates all the same arguments, but one that struck me in light of Jimmy's "taking less meds" argument, was citing Dr. Mary Vernon as [one of the] "plenty of doctors out there ... who do know the long-term effects of a low-carbohydrate diet for their diabetic patients.  Those effects include weight loss, lower fasting glucose, reduced reliance on drugs, and even a complete reversal of diabetic symptoms in some cases.   Let's look at one such success story, shall we?  Vernon has a business -- gasp! -- that sells services to, amongst others, diabetics.   Now ... maybe the website is in need of some updating, but here is just one Success Story
    "By October of 2009 Pam’s blood sugar level was usually 350-400 even though she was taking 80 units of insulin at each meal and 125 in the evening. She experienced bruising and pain from the shots and was beginning to question whether or not they were worth it. She felt horrible, she wished she could lose weight, she wished she could regain energy, but she was beginning to feel like giving up, like there was no hope. As a last ditch measure, her daughter, an ED nurse at Ransom Memorial, suggested that she see Dr. Mary Vernon.After her initial comprehensive evaluation, Dr. Vernon suggested specific dietary and medication changes for Pam. In her first month under Dr. Vernon’s care Pam lost approximately 15 pounds. What Pam finds even more exciting than the weight loss is what is happening with her diabetes and the way she feels. Her blood sugar levels are now 180-200 and she has reduced her insulin intake by half."
    So anxious is Vernon to lower medications she's willing to let a patient continue with dangerously elevated blood glucose levels.  THIS is a success story?  It's now July 2011.  How is Pam doing?   Perhaps, at least she's off the metformin.  Metformin appears to be Fat Head's bigger target for evil medication du jour.  Is it Fred's turn yet?  Sorry, one more sanctimonious blogger left to address first.  That being Amy Dungan.  Yes, I don't use that term lightly, but this woman really has some nerve smearing folks like Warshaw when she so clearly doesn't even practice what she preaches while shilling for candy cigarette manufacturers.  No, her "I'm not perfect" disclaimer doesn't even begin to excuse her behavior.   In her contribution to the derision of Hope, we have:
    I’ve heard the lame old excuses over and over. “But diabetics deserve to eat the foods they like!” Deserve? It makes me wonder if the people that say that hate diabetics. Because eating all those foods they “deserve” also means they’ll have to take medications or get shots. Do they “deserve” those too? I think what people really deserve is the knowledge that the correct dietary choices can free them from large amounts of medications, not to mention save them money. The correct dietary choices may save their lives.
    Fine words from someone who has probably been more off low carb than on during her past decade of loving and preaching the glories of LC.   Warshaw is talking about how realistic a diligent low carb diet is in controlling blood sugars.  Is eating a balanced diet supplemented with insulin really worse than constantly falling off the wagon, significant weight cycles and shunning medications?  Really?  Oh, but Amy the candy cigarette pusher has an explanation for all this (also mentioned by others).  It's the money, she says as she lists the sponsors of the ADA.  Yes, all those companies who make drugs that are helping people and folks like Warshaw are not just ignorant, they are in it for the money.  Hmmm... seem to remember someone I know getting lambasted for suggesting that someone's income may influence their objectivity.  Sigh.  Meanwhile Amy, Jimmy and others all sport CarbSmart sponsorships or ads or both.  And I can't help but notice that Google Ads is splashing MediFast ads across the pages of some of these holier-than-thou smear campaign merchants this past week.  Put your integrity where your mouth is.  Don't control the ads you say?  Ever consider not running them then?  How do we spell H.Y.P.O.C.R.I.T.E?  How can you folks list these ADA sponsors with a straight face while your pages are more than just occasionally graced by ads for same or even more questionable supplements and such?   (Let's not mention that I'm pretty sure a jpg named 3monkeysaltered is probably not the original work of Ms. Dungan ... speaking of Pot, Kettle and all that from someone who was all upset over supposed image theft.  Blogger heal thyself!) 

    Two more, and I'm done here.  Yes, it's Fred's turn now.  He weighed in here, and what caught my eye was the comments similar to Amy's.  Before I quote those let me state that I personally agree with the spirit of what these two are saying, I just disagree with the inconsistent manner in which they apply the standard.  Never one to shy away from hyperbole, Fred writes:
    what Hope is penning is almost criminal. What she writes, in my humble opinion, is tantamount to malpractice for an R.D.
    Please.  The guy equates beta cell impairment to giving peanuts to an allergic person or gluten to a celiac.  C'mon now, how about a little seriousness in this debate.  Diabetes is not a "disease of carbohydrate intolerance" in the same manner as these.  It -- the hyperglycemia -- is a disease of either insulin insufficiency, insulin resistance or both.  Insulin is no more a "drug" the various estrogen replacement therapies countless women have taken (including Mary Dan Eades) or the thyroid hormone therapies countless men and women (including Dana Carpender) take for insufficient thyroid function.  Warshaw is talking leading a "normal" life, and that includes the occasional bun on a hamburger and not some ridiculous substitute made of eggs and cream cheese, and by no means the SAD that, at 45% carb (including veggies) is also usually 40-45% fat as well.  It is well known that extreme carb restriction lowers thyroid function.  So might Fred be getting on his Royal Carbanian Mounted Internet Police steed anytime soon to denounce the criminal behavior of those advocating such diets for those who are already hypothyroid?

    Fred's position boils down to LC is the best diet.  Don't bother him with studies. The point Warshaw is making is that ultimately it is the practical *reality* that the recommendations must address.  The  65% carb is a bit over the top (if you're counting actual veg carbs however it's not so out there for many of us), but Warshaw is giving similar advice to relatively low-carb advocate Dr. Michael Dansinger.  You'll recall from earlier in this post, Jimmy cited Dansinger.  What Dansinger have to say about the diets in his study however?  Basically that it was a wash and that compliance, not dietary approach, was the key.  Dansinger is a doctor who uses a relatively low carb approach -- not a VLC one, however -- to reverse diabetes.  I guess he's a sell-out too for doing that The Biggest Loser gig.  Sigh.

    I think the Queen of the Ball of Hypocrites, however, has got to be Dana Carpender.  She of "fighting the low fat lie" for 15 years jumping on the bash Hope bandwagon.  Oooh ... Newsflash, her husband has weighed in too.  Nothing new under the sun in either posts other than repeating the same old.  But Dana's hubby does seem fit to again list all the sponsors of the ADA.  Here's just the top billed ad sponsorship of Dana's blog currently:
    OK, the ADA brought to you by pharmaceutical companies and medical device manufacturers, but Hold the Toast brought to you by Medifast and Candy Cigarettes!  This really wouldn't be that repugnant were it not for the fact that, after 15 years on her supposedly healthy high fat low carb diet, Dana wasn't actually taking not one, but two diabetes medications.    Yes, Tom, instead of her Dr. Andry addressing the high fat diet that may well be contributing to her hepatic insulin resistance/PCOS, he put her on metformin!  And when that didn't work, he put her on Victoza.  For those unfamiliar with that drug, it's a bit like Byetta but a once-a-day version.  These two drugs are GLP-1 mimetics that act by (a) stimulating insulin secretion (GASP!!), (b) suppressing glucagon and inhibiting glucose release from the liver, and (c) slowing gastric emptying.  (They also tend to lead to weight loss).   Now perhaps the makers of her particular drugs aren't ADA sponsors, but I think they have a word for this sort of thing.  Chutzpah!  And doubly so because for the time being Dana is taking samples provided to her doctor to "push" on her I suppose.  That's what Big Pharma does you know.  It sets out salesmen loaded with samples to get the doctors to prescribe their products.   Dana seems to have no compunction over getting freebies of this nature.  

    Do these people live in some parallel universe or something?  Seriously.   

    What do almost all of these sanctimonious hit pieces have in common?  Well, there's that advice on what you can do to counter the demise of low carb dogma.  Join the Nutrition and Metabolism Society (paid membership) so they can get their message out.   It smells of those political fundraising campaigns launches over inflammatory stories.  Dana's husband sure seems to imply these talking points were circulated about.  

    Not for nothing, but who is on the board over at NMS?  Well, for one, none other than Dr. Jeff Volek.  Now I have no reason to think ill of this man or question his integrity.  LET ME BE CLEAR.  But Volek has published studies conducted on grants from ... drumroll please ... The Atkins Foundation (who provided Atkins bars and shakes for at least one study).  Oh, and coming full circle to Cooksey's slam on Warshaw on perpetuating the need for her books, Volek is the author of not one, not two, but three diet books  (TNT, New Atkins, Art & Science of LC).  Don't get me started on all the bloggers and Warshaw critics selling their own books, testing supplies, supplements, gym memberships and whatnot.  I don't suppose any of these people slamming the ADA in general, and Hope Warshaw specifically --  I hold NO brief for either -- see the irony of their own twisted web of sponsorships, financial interests, and such?    As Jimmy Moore continues to have his site sponsored by or bearing ads from Atkins and Quest bars (he could do the n=1 experiments any day now!) and CarbSmart, as do so many others, and Tom & Dana host Medifast and Jillian Michaels ads, and Amy keeps going with her candy cigarette giveaways sponsored by these same crap food peddlers adding the most insulinogenic component of dairy to their smoothies and baked goods, I ask:  

    Have they no shame?   Seems not.


    46 comments:

    eulerandothers said...

    @carbsane,

    'Before I quote those let me state that I personally agree with the spirit of what these two are saying, I just disagree with the inconsistent manner in which they apply the standard.'

    What IS the spirit of what these two are saying?

    Having just read through Fred Hahn's blog post about Hope Warshaw (in which he exhorts his readers to contact DiabetesHealth and protest), it is a mean spirit, whatever else it is.

    Inconsistent? Yeah, he's all over the place, even in that one blog post I read. It's that religious fervor, however, that is just plain creepy, the sponsorships issues aside.

    kds said...
    This comment has been removed by the author.
    CarbSane said...

    I *think* what they are trying to say (perhaps I'm being charitable) is that for those who have health/life threatening conditions the "prescription" may be non-negotiable. For instance, a person gets diagnosed T1, it is doubtful they can live a healthy life without some attention to diet, and, yes, medication. The alternative is a hastened death and/or complicated life.

    I guess we all feel a right to be able to live w/o the worries of our neighbor, but we all have our crosses to bear of one sort or another. So if this is what they're saying I'd say I just disagree with the degree and nature of the intervention required. I disagree that the "LC pill" is inherently better. And even if it is, these people cut all sorts of slack, to anyone who doesn't want to take meds or adhere to a different stringent diet for any manner of other ills. That's OK. But along comes Hope that one can live a bit more like the rest of everyone else for longer w/o compromising their health, and she's vilified.

    I hear you, I'm not so sure their "spirit" isn't rather mean at this point.

    OnePointFive said...

    I don't think any of the US bloggers have sunk so low as the heading on a blog from the UK 'Hope Warshaw more dangerous than Osama Bin Laden ?'. I could write a lot more about the author but I don't think he deserves the publicity.

    O Primitivo said...

    Effects of a low-fat dietary intervention on glucose, insulin, and insulin resistance in the Women's Health Initiative (WHI) Dietary Modification trial. http://www.ncbi.nlm.nih.gov/pubmed/21562091

    Lucas Tafur said...

    That study is priceless, O Primitivo.

    Low fat and CVD: Over a mean of 8.1 years, a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD (http://www.ncbi.nlm.nih.gov/pubmed/16467234)

    Every paper examining specifics on cancer incidence, CVD, etc in the WHI is a gem.

    eulerandothers said...

    @O Primitivo,

    I found this to be the best part of the article you cited:

    'First, contrary to previous suggestions about adverse effects of increasing carbohydrate intake on CVD risk factors, no long-term adverse effects were observed on lipid profiles or
    levels of glucose or insulin. There were
    no significant increases in triglycerides levels or decreases in HDL-C levels, and trends for glucose and insulin levels and for estimated insulin resistance all were slightly favorable. Body weight, waist circumference, and diastolic blood pressure were significantly lower, as were levels of factor VIIc. Because there are no apparent changes that would have mitigated a potentially favorable effect on CVD, the
    lack of an appreciable CVD effect may
    be attributable to the limited decrease
    (only 2.7 mg/dL [0.07 mmol/L]) in
    LDL-C level, as well as the modest differences in other potentially favorable dietary components. Based on a large body of evidence from LDL-C-lowering trials, this magnitude of
    change in LDL-C level would be predicted to produce only a small (2%-4%) decrease in CVD risk, a value far below the power for detection in the current study. As delivered, the dietary intervention was not expected to have substantial effects on lipoprotein levels, but it is possible that a diet specifically lower in saturated and trans fat combined with increased intakes of vegetables, fruits, and grains might have led to a decrease in CVD risk.'

    Fred Hahn said...

    My blog on Warshaw's ridiculous and dangerous recommendation for diabetics to eat 45% - 65% of their calories from carbohydrate was all over the place HOW exactly?

    Carbsane, do you agree or disagree that diabetics should derive 45-65% of their calores from carbs?

    THAT is the bottom line here.

    CarbSane said...

    No, Fred, that is not the bottom line. But 45% calories from carbs if you count the carbs in veggies and whole fruits certainly works very well for many diabetics. The Med diet group in Shai consumed 50% carbs and fared very well. Better than the low carbers who reduced carb intake by 75g/day more than the 50g/day reductions for the Med group.

    So I would say that diabetics should no more be counseled to derive <10% of calories from carbs than that they should obtain that high a percentage from them.

    Warshaw's recommendation is NOT inherently dangerous. That's low carb hyperbole.

    CarbSane said...

    Oh OPF, that is just sad. It's obviously not quite to that level, but the NMS should consider moderating it's message to supporters if this is the sort of discourse it elicits.

    Fred Hahn said...

    "No, Fred, that is not the bottom line. But 45% calories from carbs if you count the carbs in veggies and whole fruits certainly works very well for many diabetics."

    Hope recommends whole grains and you know it. Yes, 45% carbs from celery and broccoli is a VERY different thing. But no one eats like that and that is NOT Hope's message in the least.

    "The Med diet group in Shai consumed 50% carbs and fared very well. Better than the low carbers who reduced carb intake by 75g/day more than the 50g/day reductions for the Med group."

    The Med dieters only ate 1500 - 1800 calories. That's near starvation and micronutrient deficiency. Try 45% cals ad libitum and see what happens! And over at my blog, Alex's comments addressed the low carb issue. It makes absolutely ZERO physiological sense that a group that ate more carbs fared better for diabetics. Just try and stop your quasi-anti-low carb tape for a second and think about it.

    "So I would say that diabetics should no more be counseled to derive <10% of calories from carbs than that they should obtain that high a percentage from them."

    Really? Why? Because in the Shai study people who supposedly ate more carbs than another group did better? We don't even know what they ate? And I pointed out MANY problems with the Shai study that you simply ignored. Don't deny it now.

    "Warshaw's recommendation is NOT inherently dangerous. That's low carb hyperbole."

    Yes it is and you darn well know it is. I DARE you to go and tell a person with raging T2D to eat 45-65% of their calories from carbs without calorie counting by eating whole grains, fruits and vegetables. That is Hope's recc.

    And if you do keep carbs below 10%, guess what? You have to lower your meds. What does that tell you?

    Thomas said...

    @carbsane-assuming adequate dietary protein and fat intake for health, and a reasonably good food quality, isn't food volume (calories) the most important/baseline determinant of a successful diet for diabetics (or anyone), not macro ratios? Am I being too simplistic? It seems that the argument for ratios is one that assumes a person can over consume and still be successful.

    Thomas said...

    A problem with LC is the ad libitum eating argument. That may work for some, but it absolutely doesn't work for all and in the long run, when people go off the low carb diet (as most do), ad libitum eating is THE major problem. Teach people to moderate their volume consistently over time (LC can be part of this, although it's probably more about increased protein than low carb), and they will more likely be successful with their weight and health issues.

    CarbSane said...

    O'Primitivo: Does that study look at diabetics? I'm efforting the full text.

    Muata said...

    @Thomas - I was thinking the same thing!

    @Fred - If a person is a T2 diabetic, and need to lose weight, why on earth would you tell them to not count calories?

    Fred Hahn said...

    We are talking biochemistry here Thomas not if a person can or can't stick to a particular diet.

    Diabetes is a disorder of carbohydrate tolerence. Occams' Razor. The less carbs a diabetic eats, the less meds they require. the more, the more. It's that simple.

    There is not a single diabetic that would do better eating more total carbs than less assuming the type of carbs are of the healthiest, low GI kind.

    FE: A diabetic that ate 30% of her cals from high GI carbs like bread and pasta would probably fare worse than a diabetic who ate 50% of her cals from carbs from fruits and veggies.

    That said, the person who was eating 50% of her cals from fruits and vegetables carbs would still fare better if she lowered her carb intake to 10%. In fact, to do so cold turkey would be too dangerous because her meds might be too powerful on a diet so low in carbs.

    What does that tell you??

    Thomas said...

    Hi Fred-I would argue that reducing intake causes a much more positive biochemical response than reducing carb ratios alone (within reason of course-getting adequate nutrients, especially protein and fat, is important as well). Yes, this is without regards to whether one can stick to it or not.

    CarbSane said...

    @Fred: Hope recommends whole grains and you know it. Yes, 45% carbs from celery and broccoli is a VERY different thing. But no one eats like that and that is NOT Hope's message in the least.

    Have you watched the Warshaw v. Bernstein video everyone is all up in arms over? She says the very same thing your friend Gary says - it's not so much about the quantity but the quality. The new "My Plate" is 1/2 fruit and veggies and only 1/4 grains. Those grains can be things like rice, quinoa or starchy veggies. There's no reason to presume that means bread, cereals, and worse, pastries and such.

    So you're defaming a person because you misrepresent what she is advocating.

    This notion that 1500-1800 cal/day is near starvation is absurd. This nonsense comes from the Minnesota experiments which bear no -- repeat NO -- resemblence to the macro (or micro) nutrient composition of the Med diet consumed in Shai. It's also more than most women following low carb to a tee actually eat as well, and around what Eades himself claims he eats. But ... so now you're claiming that a starvation diet improved their diabetes? Ad libitum does NOT equal eating MORE calories. If ad lib LC leads to overeating, a person will gain weight. Or have you not seen Jimmy on the past, like, well, every dang cruise?? The LC group in Shai reported eating FEWER calories than the Med group. (What's that you were saying about my abilities to read and absorb things again?) Taubes makes the same mistake or, I contend, deliberately misrepresents ad libitum to equate with eating more. FALSE.

    No, my statements is not based on Shai alone. It's based on several long term comparison studies and the fact that VLC'ers never regain their ability to process carbs. There's evidence VLC at maintenance might even hasten the demise of their beta cells. If the goal is reversal of diabetes in the greatest proportion of the diabetic population, LC doesn't look very good.

    Yes, Thomas, I think that ad libitum in a person who has "messed up" appetite/hunger/satiety signalling/processing (and much of this can be no more than just obsessing over calorie content, eating "forbidden" foods, etc.) is a problem when eating a "balanced diet" including those highly palatable carb+fat foods. Indeed a while back there was a discussion of several ad libitum low fat trials that produced weight loss, and I remain "obsessed" with the results of the study where they simply replaced 15% calories from fat with protein calories and the women spontaneously cut calories by like 450/day.

    Jimmy Moore is overeating low carb, gaining weight, and according to his Julian Bread n=1 experiments has fasting blood glucose levels creeping up close to prediabetic range. I'm willing to bet based on his extremely high LDL but low trigs that he has very elevated NEFA (a diagnostic marker for diabetes/risk Fred). He seems to have reasonable glucose tolerance at this point.

    Fred Hahn said...

    "Hi Fred-I would argue that reducing intake causes a much more positive biochemical response than reducing carb ratios alone (within reason of course-getting adequate nutrients, especially protein and fat, is important as well). Yes, this is without regards to whether one can stick to it or not."

    Thomas - can you explain how lowering fat, for example, helps control blood glucose or restore pancreatic beta cells better than lowering carbohydrates?

    Diabetes is a condition of carbohydrate intolerance - not calorie intolerance. If your diabetes gets better on a reduced calorie diet then the carbs have decreased.

    CarbSane said...

    @Fred: We are talking biochemistry here Thomas not if a person can or can't stick to a particular diet.

    Actually, we're talking physiology moreso than biochemistry ... but that's a nit pick.

    Diabetes is a disorder of carbohydrate tolerence. Occams' Razor. The less carbs a diabetic eats, the less meds they require. the more, the more. It's that simple.

    This is where you are wrong Fred. This view is short sighted and overly simplistic. Carb restriction for glycemic control is treating the symptom, not the underlying pathology. For it to do that, in most (those for whom a degree of adiposity induced insulin resistance, basal hyperinsulinemia and/or impaired acute insulin response), this approach only works to reverse the diabetes if a caloric deficit is established corresponding with weight loss.

    In the short term, insulin-assisted diabetics will require less insulin if they consume fewer carbs. The point I am making is basically "so what?". Supplementing pancreatic inefficiency with insulin is not the same as taking many of the other diabetes drugs. It's more akin to HRT for menopausal women or thyroid for hypos.

    http://carbsanity.blogspot.com/2011/07/diabetes-crash-cures-vlcal-vs-vlcarb.html

    The 60g/day folks on NO meds had a 100% reversal of diabetes at 8 weeks, and a 70% retention of the result at 20 weeks despite increasing carbs. How does you overly simplistic point of view explain this? Meanwhile, on <20g/day, the ketogenic diabetics (admittedly worse off at the start and almost all on some meds) experienced modest improvements at 12 weeks but not much further improvement at 24 weeks. Of course they needed less insulin than the other group (comparing the results for 8/21 to 3/29 is a bit of a stretch anyway, but...) but look at the other meds (Table 3 in the study linked in that post). I am efforting getting the info on all subjects, but all 3 taking metformin to start were still taking it at end, and only one at a reduced dose. The person with a mixed therapy (subject 8) only had insulin reduced. (Keep in mind that 7 of the 11 subjects in the "starvation" study discontinued metformin on the outset of that study).

    Fred, if you want to discuss this further, please do actually read and make an attempt to absorb what it is that I am saying. There's nothing inherently harmful or wrong-headed about Warshaw's advice. It may not be the optimal approach for everyone, but neither is low carb. At maintenance -- especially if that maintenance is still of a considerably over-fat body -- there is a mountain of evidence that the high absolute and percent fat content of VLC diets exacerbates the underlying pathology of T2, or at the very least prevents it's reversal to where a person can consume a reasonable amount of whole food carbs INCLUDING starches.

    OnePointFive said...

    Fred, please don't make such sweeping statements. Yes there are a group of diabetics who adopt low carb diets and do well. There are others that use alternative (mainly lower GI or med style diets) and also get good results. I ran a marathon in April, eat about 1800cal a day(the right amount for my age and gender so certainly not starving) About 45% of my diet is carb. This includes veg, fruit, legumes, dairy and the dreaded whole grains, almost all of it is 'real' food', almost nothing industrially produced. For starchy carbs I choose lower GI ones though I may eat some fast carbs during a long run . I have to admit, I'm not T2 (but you didn't specify saying 'there is not a single diabetic... well I'm a single diabetic that breaks your'rule')
    I also know several T2s online and a couple personally who are able to gain good control managing their diabetes in this way...though marathons aren't de rigeur.
    The dietary guidelines here (France) are similar to those suggested elsewhere in the world. They do seem to be much better taught with courses of normally a weeks duration.
    I have also met T2s that have been taken into hospital for 3 weeks therapeutic education' an period where they 'have' to eat the recommended diet and do some exercise. Somehow when people eat consistently to the guidelines they gain control. According to you that shouldn't be possible.

    CarbSane said...

    @Fred: Dana Carpender eats very low carb pretty consistently. She's now on metformin and Victoza. As your buddy is fond of sneering at his lecture audiences - "how's that working for her".

    Also, why doesn't Bernstein then just advocate a zero carb diet?

    Lastly, I think this view of insulin therapy -- that before insulin was discovered they treated diabetes with a low carb diet -- is ridiculous. That's like saying that before hypodermic needles were invented, leeches were an effective treatment for hemochromatosis. Absurd! We have identified the hormonal dysfunction -- a hormone that has myriad other functions in the human body besides just glucose disposal. It should at least be debated honestly whether artificially mimicking normal physiological insulin responses is not at least equivalent, if not preferable (where I stand, and what I would do were I diabetic) to just keeping it as low as possible.

    eulerandothers said...

    @Fred Hahn.
    Here are some things that made me think you are 'All over the place':

    1.
    'she (Hope) says that the ADA wants diabetics to derive 45% to 65% of their caloric intake as carbohydrate? I checked and this is not exactly what the ADA says but Hope sure is saying it.'

    Then,
    'Take that recommendation in my peeps. The ADA and Hope thinks it’s A.O.K for a diabetic to take in most of the calories they eat as carbs.'

    OK, did the ADA say that or not? You state that the ADA and Hope both said that.

    2.
    Having already said,
    'And according to the USDA, the 2010 Dietary Guideline do not apply to diabetics or anyone with a health/medical condition. Shouldn’t Hope know this?'

    Then, this follows:
    'Why is she telling diabetics they should eat sufficient amount of carbs? For what purpose? Doesn’t she know of and hasn’t she read the National Institute of Health’s DRI report, specifically the section on carbs? Here it is:

    Clinical Effects of Inadequate Carbohydrate Intake
    The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed.'

    What does one have to do with the other? What does the 'lower limit of dietary carbohydrate compatible with life' have to do with recommendations for diabetics? From your statement, you seem to say that one follows the other in some meaningful way.

    Lucas Tafur said...

    @CarbSane,

    Some excerpts from the paper OPrimitivo linked:

    "Similar to the overall findings in the WHIDMtrial,women in the intervention group had significantly lower self-reported intakes of
    energy, total fat, saturated fat, polyunsaturated fat, and trans fat
    than did women in the comparison group at year 1"

    "However, whereas women without diabetes at baseline had a mean (95% CI) decrease in glucose at year 1 that was 1.9(0.3, 3.6) mg/dL (in women with normoglycemia) and 1.8 (21.0,4.6) mg/dL (in women with impaired fasting glucose) greater in
    the intervention group than in the comparison group, and women with diabetes had an increase in glucose at year 1 that was 7.9 (3.5,12.4) mg/dL greater in the intervention group than in the comparison group (P for interaction ,0.001).

    And, you will love the following:

    "Similarly, women in the intervention group who consumed the greatest amount of carbohydrate as a percentage of energy at year 1 had the greatest increases in QUICKI and trends toward greater decreases in glucose and insulin."

    "At year 3, women with the greatest reductions
    in total fat intake had statistically significant trends toward decreasing glucose and insulin concentrations and HOMA-IR and increasing QUICKI. Also at year 3, women with the greatest increases in carbohydrate intake had significant trends toward decreasing glucose concentrations and increasing QUICKI.
    Women in the intervention group who consumed the greatest amount of carbohydrate as a percentage of energy at year 6 had the greatest increases in QUICKI, which was significant with and without adjustment for weight change at year 6."

    In conclusion:

    "In summary, a reduced-fat dietary pattern with a corresponding increase in the proportion of carbohydrate overall was not significantly
    associated with adverse effects on glucose or insulin concentrations, or on insulin sensitivity/resistance, in this group
    of postmenopausal women. However, women with diabetes at baseline did experience adverse glycemic effects of the low-fat diet, which indicated that caution should be exercised in recommending a reduction in overall dietary fat in women with diabetes unless accompanied by additional recommendations to guide carbohydrate intake."

    eulerandothers said...

    (continued - there's a size limit to posts)

    3.
    'You also won’t find a single comment in support of Hope’s hogwash.'
    Your blog was written on July 6. The supportive comment from Nadia Al-Samarrie was posted on July 6. Yet you state that there wasn't a SINGLE COMMENT in support of the 'hogwash.'

    You noticed the comment, because you discussed it at length. The comment links to an entire article addressing and supporting
    Hope Warshaw.

    All over the place? I feel like I'm watching a bouncing ball. You can't use the delete key on your computer to edit out that 'You also won't find a single comment in support of Hope's hogwash'? When you go on to discuss at length not a comment but an entire supportive article?

    You also overlooked this person, who posted on July 5:

    'Posted by Anonymous on 5 July 2011
    My earlier comment has not been posted, but I want to agree that controlled carbohydrate with moderate protein and sufficient saturated fat works for me. A1c of 5.6 down from 13 for seventeen years.'

    Duly noted, anonymous! By me!

    You have plenty of comments about Ms. Al-Samarrie's article. Including some clairvoyant remarks ('What Nadia doesn’t know or can’t come to grips with, is she’s a sugar addict. She want’s her sugar and by gum (sugar free, right Hope?), she’s going to have hers.')

    What you didn't discuss was this paragraph in Ms. Al-Samarrie's article:
    'We will soon publish an article about a type 1 who diligently tried the low carb diet and still suffered from a high A1C. Low carb did not work for her. It wasn't until she persuaded her physician to prescribe metformin for her (which is generally prescribed for people with type 2, not type 1) that she achieved success. After going on metformin, she finally realized normal blood sugar. What works for one may not work for another.
    I would like to ask you to be tolerant of other opinions and support whatever modalities allow your peers with diabetes to achieve the success that rewards you. It should not matter what diet people are on, as long as they achieve an A1C that offers them the quality of life that we all want for one another?'

    eulerandothers said...

    (continued)
    4.
    You addressed a comment from carbsane with this:

    'You don’t control blood sugar by eating a lot of carbohydrate. To argue this point is ridiculous. Do you think a diabetic should derive 45-65% of her calories as carbs no matter what those carbs are? It’s a yes or no question.'

    However, you provided the link to Hope's article, so you must have read it. What she said was that: 'People with type 2 diabetes, like the general public, should lighten up on added sugars and sweets (yes, they're carbohydrate). They should eat sufficient amounts of fruits, vegetables, whole grains, and low fat dairy foods--all healthy sources of carbohydrate.'

    So where does '45-65% of her caloriees as carb no matter what those carbs are?' come from?

    Fred Hahn said...

    "Have you watched the Warshaw v. Bernstein video everyone is all up in arms over? She says the very same thing your friend Gary says - it's not so much about the quantity but the quality. The new "My Plate" is 1/2 fruit and veggies and only 1/4 grains. Those grains can be things like rice, quinoa or starchy veggies. There's no reason to presume that means bread, cereals, and worse, pastries and such."

    Yes I have seen the video. She says "Whole grains." That means bread and pasta is included. Her books include bread and pasta as ok foods to eat. Please Carbsane. Stop sicking up for a person who is almost clueless when it comes to how a diabetic should eat.

    "So you're defaming a person because you misrepresent what she is advocating."

    Defaming? LOL. I'm telling the truth. Is it called defaming if I say that George W. Bush is a criminal for starting the Iraq war? If so, so be it.

    I did say she seems sincere and is pleasant enough. But what she is saying is wrong, misleading and dangerous to diabetics.

    "This notion that 1500-1800 cal/day is near starvation...so now you're claiming that a starvation diet improved their diabetes?"

    First of all, it is indeed near starvation especially if one is eating a USDA Hope Warshaw diet that is low in fat and rich in grains. That is what I meant.

    1500 - 1800 cals of fatty meats is a whole nother ball o wax.

    "Ad libitum does NOT equal eating MORE calories. If ad lib LC leads to overeating, a person will gain weight. Or have you not seen Jimmy on the past, like, well, every dang cruise??"

    I didn't say it led to overeating. I was suggesting that an ad libitum Hope Warshaw diet will allow diabetic people to over-consume carbohydrates.

    "The LC group in Shai reported eating FEWER calories than the Med group. (What's that you were saying about my abilities to read and absorb things again?) Taubes makes the same mistake or, I contend, deliberately misrepresents ad libitum to equate with eating more. FALSE."

    What it really means is that calories are not controlled for, not that people WILL over eat. Taubes doesn't misrepresent anything. You just take what he says the wrong way for some reason I can't fathom.

    "No, my statements is not based on Shai alone."

    Shai thinks low carb is best. Like I said, just ask her!

    "It's based on several long term comparison studies and the fact that VLC'ers never regain their ability to process carbs."

    That's absurd. It takes some time to readjust just like it takes time for vegans to readjust to meat. Why not post an example of a paper that supports your statement on this.

    "There's evidence VLC at maintenance might even hasten the demise of their beta cells. If the goal is reversal of diabetes in the greatest proportion of the diabetic population, LC doesn't look very good."

    Oh please. Show me the money CS!

    Yes, Thomas, I think that ad libitum in a person who has "messed up" appetite/hunger/satiety signalling/processing (and much of this can be no more than just obsessing over calorie content, eating "forbidden" foods, etc.) is a problem when eating a "balanced diet" including those highly palatable carb+fat foods. Indeed a while back there was a discussion of several ad libitum low fat trials that produced weight loss, and I remain "obsessed" with the results of the study where they simply replaced 15% calories from fat with protein calories and the women spontaneously cut calories by like 450/day.

    Jimmy Moore is overeating low carb, gaining weight, and according to his Julian Bread n=1 experiments has fasting blood glucose levels creeping up close to prediabetic range. I'm willing to bet based on his extremely high LDL but low trigs that he has very elevated NEFA (a diagnostic marker for diabetes/risk Fred). He seems to have reasonable glucose tolerance at this point.

    eulerandothers said...

    5.
    You state:
    'I have no personal vendetta against CS.'
    But immediately follow it up with this:
    'And I have already shot down her arguments. And if you read her blogs you’d know that I am right.'
    (Add to that this previous quote from you: 'Carbsane clearly has it out for Taubes and other staunch LC advocates and thinks she understands the subject better than Taubes, Eades, Feinman, Volek, Westman, Vernon, Phinney, etc. when in truth her ability to read, absorb and think through the LC research is lacking.')


    I must admit I'm on the fence about this. Disagreeing with someone does not have to lead to insult. You bounce between being insulting and then claiming that it's 'not personal.' Not only do you claim not to have a personal vendetta, but you then say that carbsane does!

    Fill in the blanks, I guess:
    Let me add that, while I have no vendetta, I see a vendetta on YOUR part, and you have it out for W,X, and Y (pot...kettle, huh?) I also have some idea that you are addicted to Z!

    It's true that pointing out a disagreement with another person does not by itself mean a 'personal vendetta.' Then why the mean-spirited accusation that carbsane (personally) doesn't have the ability to read through and understand research? That's a real surprise to anyone who reads her blog. And if you personally know Ms. Al-Samarrie, then I guess her 'addiction' is now public knowledge. Is she going to appreciate that? You must know her 'personally.' (I don't.)

    CarbSane said...

    Reversal = normal glucose tolerance and insulin production

    Remission = normal glycemia but impaired beta cell function and insulin production.

    I'll let you have the last words because discussing nutrition, biochem, physio, whatever with you is the ultimate futile cycle. Hopefully it burned off a few calories.

    Nigel Kinbrum said...

    CarbSane said...
    "In the short term, insulin-assisted diabetics will require less insulin if they consume fewer carbs. The point I am making is basically "so what?""

    What do you think of The Laws of Small Numbers?

    KD said...

    Onepointfive when you talked about marathon running you brought up something that I have been curious about.

    I've tried the lower carb diets on and off, and when it comes to any sort of sustained exercise, I have always felt more sluggish when on the lower carb diets.

    I used to spend three or four hours in the pool a day. I couldn't possibly imagine doing that without getting a substantial amount of my calories from carbs.

    CarbSane said...

    @Nigee: I'd say Bernstein is arguing at the extremes. His diet, as I understand it, is 6 + 12 + 12 = just under 30g/day carb. He wants to compare that with 150 + 150 + 150g = 450g/day carb. A 150g carb bowl of pasta is a good sized bowl. I'll say! Despite claims, the average non-diabetic thin person is not consuming 450g/day of carbs. That's 1800 cal/day of carbs. In the 1970's that would be 120% the average American woman's daily intake, and almost 75% for men. A more practical comparison would be the law of "reasonable numbers", shall we say. So 40g per meal = 120g total = 480 cal. This would be perhaps 30% carb for women. I note she doesn't say everyone should consume 65% carb. For the 2450 cal consuming male, 45% = 275g or under 100g for each meal, and for the 1550 cal woman eating 65% carb we're down near 250g total or just over 80g/meal for a 3 meal/day regiment.

    Since Bernstein devised his dietary recs, insulin therapy and adjunctive therapies have advanced dramatically. Basal insulin pumps for example, and the GLP-1 mimetics are being shown to help T1's considerably with glycemic control. Insulin pumps are really game changers in all of this.

    I don't know if you frequent any of the forums of low carbers, but almost daily you'll see a post from someone beating themselves up over falling off the wagon and how they know this is the only way for them to beat their diabetes, holding off on taking insulin or other meds and doing far more harm to their bodies trying to listen to all the LC "experts" when they just might be able to thrive following Warshaw's advice. I'm not saying she's right or wrong ... I suspect most will do better on the low end of her scale and getting at least a third or more of total carbs from fruits and veggies. But this "she's killing people" stuff is over the top.

    eulerandothers said...

    (continued - somehow, 3. got lost!)


    3.
    'You also won’t find a single comment in support of Hope’s hogwash.'

    Your blog was written on July 6. The supportive comment (actually, a comment containing a link to a supportive article on DiabetesHealth) from Nadia Al-Samarrie was posted on July 6. Yet you state that there wasn't a SINGLE COMMENT in support of the 'hogwash.'

    You also didn't notice another supportive comment that preceded it? You didn't mention it.

    You could use the delete key on your computer to edit out that 'You also won't find a single comment in support of Hope's hogwash'!

    The overlooked other comment, from a person who posted on July 5:

    'Posted by Anonymous on 5 July 2011
    My earlier comment has not been posted, but I want to agree that controlled carbohydrate with moderate protein and sufficient saturated fat works for me. A1c of 5.6 down from 13 for seventeen years.'


    While evaluating Ms. Al-Samarrie's article, you include some srange remarks about her ('What Nadia doesn’t know or can’t come to grips with, is she’s a sugar addict. She want’s her sugar and by gum (sugar
    free, right Hope?), she’s going to have hers.')

    What you didn't discuss or mention was this paragraph in Ms. Al-Samarrie's article:

    'We will soon publish an article about a type 1 who diligently tried the low carb diet and still suffered from a high A1C. Low carb did not work for her. It wasn't until she persuaded her physician to prescribe metformin for her (which is generally prescribed for people with type 2, not type 1) that she achieved success. After going on metformin, she finally realized normal blood sugar. What works for one may not work
    for another.
    I would like to ask you to be tolerant of other opinions and support whatever modalities allow your peers with diabetes to achieve the success that rewards you. It should not matter what diet people are on, as long as they achieve an A1C that offers them the quality of life that we all want for one another?'

    Fred Hahn said...

    Carbsane - I think we'd all like to hear what you'd recommend as a general diet for a diabetic.

    CarbSane said...

    I've obtained the full text of Lucas' study and posted a new "Join the Discussion" thread. Please contribute further comments (and perhaps C&P your contributions here on that specific study) to that thread/discussion: http://carbsanity.blogspot.com/2011/07/join-discussion-on-effects-of-lf-diet.html

    Fred, clearly some diets work better for some diabetics than others, there is no general diet. Perhaps you and the NMS folks should focus your "assault" less on character assassination of Hope Warshaw and bombard the ADA with all your awesome scientific studies demonstrating the long term superiority of LC to reverse diabetes.

    OnePointFive said...

    'What do you think of The Laws of Small Numbers? '
    Bernstein says 'The key is to eat foods that will affect your blood sugar in a very small way'
    From a practical point of view a full English Breakfast (bacon, eggs, sausage) for me needs as much insulin to 'cover' as my normal porridge and berries and contains far more calories!.So what have I gained?
    All carbs and all proteins are not equal in the amount of insulin elicited in non Ds. Food insulin index: physiologic basis for predicting insulin demand evoked by composite meals http://www.ajcn.org/content/90/4/986.long

    Fred Hahn said...

    Cop out Carbsane. Are you suggesting that given the same exact foods, some diabetics do better on higher carb intakes than others?


    Many of us have "assaulted" the ADA the ADtA, and will continue to "assault" those who spew misleading and dangerous information.

    Where is the research on LCD causing damage to beta cells please?

    CarbSane said...

    Sorry euler, your #3. is now published. I can go for weeks checking spam almost daily and nothing. Forget to check? Sure enough something gets dumped there!

    Fred Hahn said...

    "From a practical point of view a full English Breakfast (bacon, eggs, sausage) for me needs as much insulin to 'cover' as my normal porridge and berries and contains far more calories!.So what have I gained?"

    I find this very difficult to believe unless you are eating a HUGE portion of protein and an eensy-weensy bit of porridge.

    Fred Hahn said...

    Carbsane - I'd appreciate it if you could post the links to the study on LCD and beta cell damage as well as the studies on long term LCD and the inability to process carbs.

    CarbSane said...

    8 am EST: I'm temporarily closing comments here to move content to discussion topics. Thanks for your patience.

    Sanjeev said...

    Hey FRED, glad to see you never change.

    Demand the sun, moon and sky from others but never produce anything yourself.

    Still waiting for you to explain how the only cause of lung cancer is smoking. That's what your words state.

    That's what you claimed. If you want to deny you claimed it, have someone who understands english explain to you THE MEANING OF WHAT YOU WROTE, BELOW.

    Did you ever satisfy ANY of the requests over on the S.P.E.E.D. forums for explanations ?

    NOPE ... you just demand and demand and demand of others and never yourself provide even 1/100th of the sheer volume you demand of others.

    ___________________________________
    Fred Hahn said...

    James K said:

    "When you say "the root cause", that implies that there is a single root cause. But why do we assume a single root cause? To me, this is one of the biggest mistakes people make in regards to obesity...assuming that the cause is univariate rather than multivariate."

    That's because there is a root cause. Everything else is a derivative of excessive carbohydrate consumption like energy surplus, less energy expenditure, hormonal disruption, etc.

    The root cause of lung cancer is smoking. There are reasons why people smoke but the root cause of the disease is the smoking itself.

    Here's a question for you and Carbsane. Do you think it's possible for people to become obese eating fatty animal products, non starchy vegetables and drinking water only? If so what would the mechanisms be?
    February 10, 2011 5:10 PM

    CarbSane said...

    ~11 am EST 7/16: I've turned the comments back on, deleted the comments on the WHI articles, and moved them to the "Join the discussion" posts I've created. If I accidentally deleted a post that was not related to those, please let me know (comment here or email), I have them and can reinstate. If you have anything further to add (and I sure hope you do!) to the discussions on those articles, add them here:

    WHI ~ Glucose, Insulin, IR
    WHI ~ CVD risk

    CarbSane said...

    Thanks Sanjeev for pointing this behavior out to those who may not be familiar with Fred's tactics around the web and the "history" that exists.

    In retrospect it was a mistake to post over at Fred's blog. Nothing I or anyone else says is going to reach Fred or those of like mind. They have their minds made up. Which is why I bowed out over there ... I have better things to do with my time.

    Bottom line, with Shai, either it has application or it doesn't. Taubes took 2/3rds of the data into account to make a "new" point, easily demolished when the other 1/3rd (Med) data is taken into account.

    There is also no denying that the Med group diabetics fared better, and I would argue overall because they were far less erratic in intake, and lost/maintained in a manner that is preferable.

    Fred, if you are really interested, then sit a spell and READ here at my blog. Tags of interest would be Lipotoxicity and Type II Diabetes.

    Physiologically there is NO substantiation for your blanket statement that was the impetus for me to react. MANY diabetics do better on higher carb diets. Your "challenge" to OnePointFive indicates your fundamental misunderstanding of the role of insulin in managing diabetes. You are out of line in that regard.

    If you're reading this, yes, I am probably about 30-40 lbs overfat. I'm about 3 sizes over-large for my original build, but realistically 1-2 sizes over-large for my current one. My bone structure has changed considerably (one's wrist size should not change absent considerable "padding" which mine do not have, yet my wrist circumference is considerably larger - e.g. I've gone from "small boned" to at least "medium" and perhaps even "large boned". I also have considerably muscle mass. So, as I told another commenter here recently, go to a Sears,Kohls or JCPenney, find a pair of size 10 Lee jeans and go ask a woman who looks like she weighs around 200 lbs to try them on. Obviously I don't want anyone to really do that, but that's where I'm at.

    Sanjeev said...

    for completeness, my other "favourite" FRED behaviours slipped my mind:

    (aside from mis-quotes, mis-attributions and straw men)

    1. the non-answer answer
    1a. "mis-understanding" the question, thus "answering" something that was not asked
    2. the non-answer hidden by sheer non-relevant volume answer
    3. change the subject (often via more demands) to hide the lack of substantive answers
    4. just go away for a while hoping people forget your "contribution"
    5. anyone who stays ON TARGET and demands substantive, responsive, ON TARGET arguments from FRED is a troll (according to FRED)

    OnePointFive said...

    Fred,
    I'm sorry that you don't seem to believe my personal observations.However if you have read the paper on mixed meals&insulin response or indeed the original work on the insulin index:
    http://www.ajcn.org/content/66/5/1264.full.pdf+html you would have noticed that it isn't just carbs that create an insulin response and that indeed some high protein foods create a higher response than carbohydrate foods.
    You will find that even very low carbing T1s need to take insulin for a low/no carb meal.(the glucagon response still works even when you don't produce insulin)
    There is an article by Dr Katherine Morrison on the N&M society website. She is a well known advocate of low carbing for T1s, including her own son. She reckons 2u of insulin for 3 eggs,I think that makes the 4u I take for bacon, egg and sausage about right, admitedly higher calories than my poridge at 3.4u, but it's the type of breakfast that many low carbers suggest.

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